Skin Cancer: Screening Guidelines

Each year more than a million people in the United States are diagnosed with the most common forms of skin cancer — basal cell carcinoma and squamous cell carcinoma — which together are known as non-melanoma skin cancers. Fortunately there are ways to detect most non-melanoma skin cancers early, when they are curable.

Melanoma, the most serious form of skin cancer, is not as common as the other two major types of skin cancer, accounting for approximately 62,000 new cases in the US in 2005. Because malignant melanoma can be deadly, and because the number of new melanoma cases has been steadily increasing over the past several decades, early detection and treatment of the disease is very important.

Skin Cancer Screening Studies

For people without a history of skin cancer in their families, no studies have been done to test the effectiveness of routine screening for melanoma. Periodic skin examinations are the key to diagnosing skin cancer at its earliest stage, when it is most easily cured. Most cases of basal cell carcinoma and squamous cell carcinoma first appear as changes in the skin, which, once noticed by the patient or primary care doctor, are then verified as skin cancer by a dermatologist after a skin examination and biopsy have been performed. Since basal cell and squamous cell carcinomas are almost always cured without specified screening, no studies have shown that such screening will improve the already high cure rates for those types of skin cancer.

Family history is a risk factor for melanoma. In addition, there is strong evidence that the risk of melanoma increases for individuals who have atypical moles or many common moles. (Atypical moles, also known as dysplastic nevi, have irregular borders, vary in color, or are asymmetrical, meaning if you cut the mole in half, the two halves would not look the same.) Other melanoma risk factors include previous melanoma or non-melanoma skin cancers, skin that burns readily and fails to tan, freckling, blue eyes, red hair, and a history of blistering sunburns. To date, there is no evidence to show that screening individuals with any of these risk factors will reduce the number of melanoma deaths.

Our Skin Cancer Screening Guidelines

Our doctors do not recommend routine skin cancer screening. We do recommend lifelong dermatologic surveillance for patients with a personal history of melanoma. In addition, we recommend that individuals identified during routine care who meet any of the following criteria be considered for skin cancer risk assessment by a dermatologist:

A family history of melanoma in two or more blood relatives

The presence of multiple atypical moles

The presence of numerous actinic keratoses (precancerous lesions that are grey to pink colored scaly patches of skin on sun-exposed areas of the body)